QUESTIONNAIRE FORMAT MS WORD Document Type-2 Diabetes patient Different options from DEVELOPER TOOL :- Check box, radio button, dropdown & combobox.

1. Questionnaire for
TYPE-2 DIABETES Patients
I. Name of the individual
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II. Date of Birth
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III. Contact Number
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IV. Gender
Choose an item.
V. When you were diagonised with diabetics?

2. Choose an item.
VI. Do you exercise regularly?
VII. Do you often check your blood sugar?
VIII. You take your anti-diabetic medicine by which
route?
Orally
subcutaneously

3. IX. Do you suffer from high blood sugar symptoms?
No
Thirst
Fatigue
Hunger
Desire to urinate
X. Have you ever attended sessions with a registered
dietitian?
XI. Have you ever been admitted in hospital due to high
blood sugar?

4. XII. Do you have othercomplication ?
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Thank you for filling the Form..!!
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